Faculty-Led Study Abroad: Winter Application

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MGT 200: Global Organizational Ethics and Social Responsibility | Bulgaria
KIN 180: Fly Fishing | New Zealand

I certify I will abide by all the rules, policies, codes of conduct, and regulations of the CSU Dominguez Hills and of the Office of International Education in particular.

I certify I am in good academic and judicial standing. I understand if I fail to meet and maintain the requirements for participation in the study abroad program, I will be ineligible to participate, and any advance payments made by me will not be refunded.

I certify that I understand that withholding information requested or giving false information will make me ineligible for admissions to the program or dismissal from the program, without refund of any costs or fees paid.

I have read Part C and agree to the terms outlined by California State University, Dominguez Hills.

I authorize to release details of my disciplinary record(s) to the CSUDH Study Abroad Office. By signing this form, I certify that I understand and authorize the release and sharing of my confidential records with CSUDH. If there is the possibility of a change in my current status, I must discuss my case with my Dean of Students or Designee. Otherwise, I may no longer qualify for a study abroad enrollment, and I may not be eligible for a refund.

I have read Part D and agree to the terms outlined by California State University, Dominguez Hills.

I, , accept that a $120 deposit is due within 10 days of submitting this form. Failure to do so may make me ineligible for certain scholarships or may result in a withdrawal from the program. NOTE: Not required for the New Zealand program.